The Naturalistic Action Test (NAT) is the product of ten years of research conducted at Moss Rehabilitation Research Institute in Philadelphia, which showed that recovering stroke and brain injury patients and those with progressive dementia are highly prone to errors of action when performing routine activities of daily living. It enables valid and reliable measurement of naturalistic action production across a wide range of patient impairment. It is suitable for patients with hemiparesis, weakness and range of motion limitations. It is also suitable for patients with aphasia as long as they can demonstrate comprehension of task instructions. 

The NAT is a performance-based test in which the tasks, materials, layout and cueing procedures are standardized and can be set up in a small assessment station. Scoring is simple and objective such that it can be performed reliably with little formal training. The additional tests materials required to administer the NAT are easily accessible in a clinical environment.

Who should use the NAT?

Clinicians who work with neurological populations will find the NAT helpful for: setting treatment goals and destination plans; educating patients and family members about types of problems likely to be encountered after discharge, as well as predicting post-discharge outcomes. Cognitive and rehabilitation researchers can use the NAT as a baseline outcome measure in treatment studies, as a functional outcome measure in treatment studies and as a functional disability measure for characterizing a study population.

How does the NAT compare with other assessments?

• It uses actual performance rather than self or informant surveys to assess vulnerability to cognitive lapses and error.

• The NAT measures accomplishment and error when left to own devices, whereas some of the most widely used functional assessments measure the degree of assistance required to get through a task instead.

• Performance is measured on an interval scale compared with dichotomous pass/fail or independent/dependent scores assigned by other instruments.

• Use is not restricted to any specific professional group, and no intensive training or rater calibration credentials are required.

• The NAT can be scored easily without the aid of a computer.

• The test was developed for and validated with a neurological rehabilitation population.

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